Stuff They Don't Teach You In Medical School: Who's The Boss

I have always believed in helping my fellow medical students. That's even why I set up this blog: so that I could share experiences and insights about the illuminating journey that is medical schoo-- ah screw it, okay fine I set up this blog because life hates me and I figured, I should at least share my misery and make people laugh. There.

Anyway as part of my effort to warn educate other medical students and members of the public, now that I'm a real doctor (I SEE YOU LAUGHING! STOP THAT! -- Editor) I thought I'd start a little series on the real-life stuff you find out as a doctor that you wish those bastar-- uh, loving lecturers had remembered to teach you in medical school.

So for our first lesson, children, I'm going to ask you a simple multiple-choice question. A simple one, but bloody hell is it an important one for doctors, students, and any poor fool who has to visit a hospital actually. Ready? Here it comes:

FROM AMONG THE FOLLOWING STAFF ON THE WARD, WHICH ONE IS THE BOSS?

Click to enlarge. Go on, it's worth it. I slaved five hours to make this! 

(OK so I suck at Photoshop. Leave me alone.)

Choose from among the following answers:

1. House Officers/Interns/Slaves - the lowest on the food chain, even lower than medical students (YES FOLKS! You think you're getting a PROMOTION when you graduate and become a real doctor? HAHAHAHAHA-- wait, you're being serious. --Ed.) and responsible for doing all the crap that other doctors don't want to do.

2. Registrars/Residents/Medical Officers (MO) - senior doctors with years of experience, one step down the food chain from big boss. They run the ward when no boss doctors are around, and are generally the source of both great teaching and great misery for junior doctors.

3. Head of Department (HOD)/Chief of Medicine/Chief of Surgery - the biggest, baddest, most experienced doctor around. Top of the ward food chain and has doctors fleeing before him in terror. House officers have been known to kiss the ground they walk on.

4. Nurses - The front line of medical care to the patients. They do the stuff even junior doctors won't/aren't allowed to do. Run things on the ward when doctors aren't around.

5. Patients - The point of the whole health service actually. Known to be either really nice or complete freakshows. If patient also happens to be a doctor, you're REALLY screwed.

Choose one. Done? Okay what did you answer? Check your number below:

IF YOU ANSWERED

1. - HAHAHAHAHAHAHAHAHA. Nice one. Seriously, I needed a laugh. Thanks.

2. - Not as ridiculous as the previous answer, but still no. Sometimes they are the boss, especially when it's 4am, the boss doctor who usually protects you is asleep, none of your friends are around, and the registrar/resident/MO remembers you as the funny-looking junior who insulted his hairstyle behind his back when you thought he wasn't listening. Oh yes.

3. - If you chose this, congratulations! You have a working brain! 90% of readers chose this option.

It is however, FALSE. Gasp! Why, you ask? Has Angry Medic lost his mind? (He has, but that's a story for another time.) I'll explain in a bit.

5. - Well...this is a tough one to explain. Patients SHOULD be in charge, especially with all this touchy-feely 'patient-centered care' crap that they pound into medical students' heads from day one. But sadly, they are not.

This leaves:

4. Nurses - That's right folks!

And don't you forget it.

A very, VERY important part of life on the wards that they don't teach you in med school (but surprisingly do in Grey's Anatomy. See Mom? And you scolded me for spending more time watching that crap than actually studying. HAH. --Ed.) is that nurses are REALLY in charge of the ward. Piss them off, and they can make life a LIVING. HELL. Treat them nicely and they'll help you put that central line in, tell you which doctors are nice and which doctors to avoid like a Justin Bieber album, and warn you wayyy ahead of time when Mr No-I'm-Just-Going-Down-For-A-Walk is actually smoking at the hospital entrance and is about to set his face on fire.

See, who says reading my blog isn't a waste of time?

*Thanks to Mother Jones RN of Nurse Ratched's Place for inspiring this post. Sort of.

What I Did Right After Getting Finals Results

The email I sent immediately after getting results. Okay so my exam co-ordinator's name isn't really Awesomesauce, but she is AWESOME. SAUCE. 
I've taken a lot of crap from some of Imperial's admin departments, but she's God's gift to administrative services. (And speedy email replies -  these two emails were like 45 seconds apart. Which begs the question - how in God's name does she type so fast?)

In my last post I mentioned that what I did right after getting my results was send an email to my university asking for confirmation that these were really exam results and they weren't playing a massive April Fool's joke on me as revenge for all the times I fell asleep in lectures. You guys thought I was joking, right? I wasn't. Here's the proof. These images are a little doctored* to protect anonymity, but they are original, complete with crappy Imperial College email client background.

Seriously. I couldn't believe it. I thought they were trolling me one last time. Only after getting that second email did I finally start to celebrate (and by "celebrate" I may or may not mean lying on the ground in a fetal position crying my eyes out screaming "IT'S FINALLYYY OVERRRR". Cough. These are emotional moments, okay?! --Editor).

*AHAHA seewhatIdidthere? "Doctored", cos this was the email that told me I'd become a doctor, geddit geddit? Yes? No? Hello? Hi mom!

The Angry Medic Becomes The Angry Doctor

My graduation at Imperial College London, October 2011.  What's that you say? 

Your mother could Photoshop better than me? Oh, shaddap.

Yes, that's right folks. Amidst stunned looks of disbelief, screams of fainting ladies and angry curses muttered by my med school lecturers, I finally graduated as a doctor in October 2011. Why the long wait to update? Cos I've been sitting here for the past few months pinching myself repeatedly asking myself if I didn't just dream the whole thing.
(I'm only joking. Partly. --Editor)

It wasn't easy. The finals were tough, and I didn't think I did as well as I ended up doing. I had a LOT of help along the way, and sitting the exams was a truly humbling experience. I could never, never have done it without the help of a few key people whom I hope to thank in coming posts (in a completely serious and non-humorous manner. Cough. Why are you looking at me like that? --Ed.) In fact, the first thing I did when I got the results email was contact the exams co-ordinator right away asking if the results were real. No, really. Don't tell my mom.

Also, now that I'm safely far far away, I can finally reveal the university I've been terrorising studying at for the past 3 years after Cambridge:

Geddit geddit? Cos it's Imperial College, and the bad guys in Star Wars are Imperials, 

so it's funny cos I drew Imperials in Imperial, hahaha...

okay so I haven't done this for a while, okay? Leave me alone.

So yeah. I'm a real doctor now. 

How does it feel? Is it worth it? Short answer: I'm scared shitless. Long answer: That's for another post, the second part to my Cambridge graduation post. (MWAHAHA now you have to come back and read more of my crap if you want to find out! Or you could...not come back. Probably healthier in the long run. --Ed.)

If you've been here before, thanks for staying with me all these years. I'll write again soon about graduation and what it's like to be a Real Doctor (in two words: scared shitless. Oh wait, did I say that already? --Ed.). Happy Chinese New Year!

The Trials and Tribulations of General Practice, Part 2

"Hello ma'am, is it ok for my medical student to help insert your contraceptive patch?"

"Um, but...he's male."

"Is that a problem?"

"What? He's MALE! What do THEY understand about contraception?!"

o_O

Censored

Recently my blog was discovered.

I've spoken many times about freedom of speech on the Internet, especially for medical bloggers. Protecting your identity becomes a lot more than just wondering what your boyfriend will think when he learns you've been ranting about your sex life online. When you have a real job, with real patients, and unfortunately very real whackjobs for colleagues and superiors, blogging becomes a catharsis of sorts.

But unfortunately it can also get you into very real trouble. Remember HospitalPhoenix. Remember Angry NHS Doctor. Even The Little Medic got into some trouble back in his student days. And now people are whispering that the highest of the high, the Big Daddy of Go-Ahead-Try-And-Find-My-Identity-Out, NHS Blog Doctor himself, was forced to retire because someone finally found out who he was.

It never mattered to me, because right from the start I wasn't anonymous, and my only real enemy was the University of Cambridge, whose policy on hate mail is basically "nyah nyah we're bigger than you". But it had to happen someday - and now it has.

I've been discovered.

And by people whose opinions, unfortunately, matter to me. You can only adopt a screw-you-I-don't-care-what-you-think policy for so long, because as every movie villain in history knows, there's always someone whose opinions you can't afford to ignore. So these days when I drag my sorry carcass into my room after a long hard day and just feel like jumping online and ranting about that midwife who yelled at me using the most colourful expletives possible --

I stop. And remember that somebody's watching me.

It feels horrible.

Happy New Year - Now Gimme Your Stuff

Brand new year! Full of energy, I walk into my hospital's locker room on my first day, brimming with love and joy and the desire to help as many patients as possible. My mind full of all the reasons I chose medicine and all the ways I can make humanity better today, I walk to my locker and see this:


Thankfully even a mince-pie-addled idiot like me knew better than to leave anything in it over the holidays. As I turn away I see this pasted on the back of the door, along with some astute medical student's scribbled warning underneath:


Nice of them to give us warning though, isn't it?

Do Not Disturb: Medical Students At Work

Newly graduated doctors, class of 2009.

As a medical student you get used to a feeling of power very quickly. Striding down the hospital hallways, stethoscope draped prominently across your shoulders and an important look on your face, patients and staff make way for you, reverent looks on their faces. There is an implicit trust across the consultation room table, even though the only lives you're going to save anytime soon are those of your greedy intestinal bacteria as you choose which sandwich you're going to have for lunch.

It is with full awareness of this trust that I bring to you these vignettes from med school. I've only been on the wards one week, but have managed to piss off two consultants, three janitors and one VERY large clinical teaching co-ordinator who may or may not have been the local wrestling champion in her original village in Africa. Stay tuned for more faith-reinforcing tales like this:

On Tuesday afternoon, three supposedly world-class medical students in a supposedly world-class university stand in the hallway of a supposedly world-class hospital. Their brows are furrowed in intense concentration, as if lives hung in the balance of their deliberations. Thick textbooks are clutched in their hands. The conversation goes something like this:

"Hey dudes. You watch House, right?"

"Um yeah. Why?"

"Cause here comes Asian Cuddy. Act natural."

"Dude, why're you using that textbook to cover your--"

"ACT NATURAL!"

Three supposedly world-class medical students, between them holding degrees in Cardiology, Surgery & Anaesthesia and Experimental Psychology, whistle nonchalantly as the Clinical Teaching Co-ordinator walks by, smiling sweetly as she chats on the phone.

"Dude that did NOT look like Cuddy."

"It so totally DID! Did you see the cleavage on that one?"

"Meh...I see the resemblance. But-- ooh she dropped a pen. She's bending over!"

Silence for a moment.

"Okay."

"Yeah."

"NOW she looks like Dr Cuddy."

More silence.

"Hey, didn't surgical rounds start like ten minutes ago?"

"SHIT."

The Power To Choose, Part One

The sun shines into the room as it slowly begins to set over the small hill behind the hospital, dotted with cottages and church steeples. I squint in the dusky light as Komrad Konsultant Kardiologist, my latest boss, flips open my end-of-term assessment form and sits down at his table.

"So, Angry...let's see." He begins.

I brace myself. Here come the hard questions about why I wasn't at ward rounds, why his patients have no idea who I am, and that one time I fell asleep in a patient's bed...

But Komrad Konsultant stops flipping the file, and looks out the window. "I think you've done quite well, Angry. I think you'll go far, in fact."

I blink. Me, going far? ME? Has he got the wrong file? What has he been smoking?

Komrad Konsultant adjusts his glasses as the sun glints off them. "You see...all this work you do now may sometimes seem pointless. All the slogging, all the early mornings, all the nasty doctors ordering you around..." He closes the file.

"What you have to remember is that you're storing choice for the future." Now he looks at me directly. "The really successful people in life, Angry, they reach a level where they can choose where they want to go. Which hospital, which specialty, which job. They write their own tickets. Everybody else, they have to hope and pray. But if you're REALLY good...you get to choose."

He signs the assessment form, ticks the 'EXCELLENT' box and hands it to me. "I think you're one of those who'll get to choose."

I sit for a while, just staring at him, stunned. Then I walk out of his room in a bit of a daze.

I don't think I deserved such high praise. Not at all. I haven't been focusing my energies where I should be lately. And to some extent I've betrayed my dream of clinical medicine, after moaning and ranting about it for three years in Cambridge. And I've made a few big mistakes. But hopefully it's not too late to correct them.

And it's not just me Komrad Konsultant was talking about. We all deserve the power to choose. So here's to working harder. Here's to storing up choice for the future. Thanks, Dr B.

Pain Management

Life's been tough recently. Events have been crashing together and teaching me the real meaning of what it means to be a clinical medic in London. Trials and tribulations never seem to stop, and come at you from all different directions - from hospital, from fellow students, from non-medical friends, even from the people you least expect.

And just like in medicine, what you thought was something you knew, turns out to be quite a different thing altogether.

Two big events have thrown me off-balance recently and forced me to seriously evaluate my direction in life. And I've also come to realise that I'm a little immature for my age. (Hey, just look at any other entry on this blog for proof. --Editor) But it's okay to crash and burn every once in a while - everybody does it. It's a human survival strategy.

The pain, however, is difficult to manage. I can't just put up a paracetamol or morphine drip like I would for a patient in hospital. So I have to work this out from basics, and do a few things that scare me. But hey, the stronger the wind, the stronger the trees.

Image credit: troymayr.com

An Awkward Moment

Ward rounds this morning in hospital with Komrade Konsultant. I am as usual performing my Oscar-winning routine of acting awake whilst actually falling asleep on the nearest comatose patient's bed. Then Komrade Konsultant's cardiac arrest pager goes off.

Everyone freezes. I snap wide awake. Ooh, a cardiac arrest! Surely he'll take some of us poor medical students along, right? Finally, I get to see if it's actually like E.R. or Grey's Anatomy. I grab my stethoscope, close my folder and almost kick some old lady's wheelchair over in my rush to get to the door--

--and Komrade Konsultant turns his pager off, tosses it back into his pocket and turns back to the patient's folder, saying:

"Cardiac arrest? Screw that, I haven't even had my Starbucks yet."


Gives you real faith in the hospital system doesn't it?

Lost In Translation

Me being examined by Dr Kim Jong-il. (Fine, so I've put on a bit of weight, okay?)

After an extended Christmas holiday spent mostly getting fat on turkey and junk food (see above picture) and trying very, very hard to get the lyrics for this hilarious Saturday Night Live music video (and it's medically-related too! --Ed.) out of my head, I returned to Stalingrad General Hospital for a week of lectures this week. And I don't know if it was just me or Komrade Professor's droning voice putting even the flies in the lecture theatre to sleep, but I heard some pretty weird stuff every time I actually paid attention to what was being said:

"You may be surprised to hear that the field of medicine is not so like to the aviation industry. In fact, the two fields are quite different." Heard during a lecture on patient safety and statistics (and almost certainly taken out of context, because I heard it as soon as I woke up.) No shit, Sherlock! DU-UH.

"Be careful what you say during your exams. I once examined a student who gave 'Huntington's chorea' as an answer, and so I followed up by asking him "So what can you tell me about chorea?" The student sat there for a second, then leaned forward slowly and, in all seriousness, asked me, "Which one? North or South Korea?" "

Okay that woke me up.

Happy New Year to my loyal readers (yes, all three of you) and stay tuned - I've got no shortage of miserable tales to keep you entertained. Now if you'll excuse me, I've got a Suicidal Medical Students support group meeting to go to. Bonne nuit!

The Chronicles of Hernia, Week 2

After enduring an entire first week of pep talks by clinical school bigwigs who spend more time posing for newspaper pictures than actually spending time with students and whom we'll probably never see again until Graduation Day, I stepped into Stalingrad General Hospital on my first day full of admonitions to "make it a positive experience" and "clinical school is what you make it" and "think positive!" (and also "for God's sake, don't accept a verbal caution from the police when you get caught piss drunk at the local pub", but that's slightly beside the point. -Ed.) So like a good little boy who's read The Secret twice cover to cover without falling asleep/clawing my eyes out/having to buy the movie instead, I gird my loins, tell myself it's gonna be an abso-friggin-lutely amazing day, and step into the hospital.

My ward is on the 9th floor. I have 15 minutes to make it upstairs. Plenty of time, right? Right. Until I see that the one lift that isn't hovering resolutely near the top floor is out of service. And just to rub it into our faces, it's even got a special icon to tell us poor sods that it's on a coffee break:


Har har. We have a comic genius on the maintenance staff! I scoot over to the stairs and leg it up 9 flights of stairs, stopping only twice to have a minor heart attack. When I finally arrive half-dead on the 9th floor but fearful of Komrade Professor's wrath, I meekly enter the teaching room but lo and behold! Komrade Professor isn't there. He's been called away on urgent business, probably to give the Queen her annual physical or check out this new wart on President Obama's finger or whatever. So us peons do some practice physical examinations, then I go out to get a drink. Returning to the room, sure to find my fellow students eager to proceed in productive horizon-widening learning, I see instead scrawled on my notes:

I'm sure they had something urgent to attend to. How nice of them to leave me a note! Ah well, I can get on with things myself. It's not like they were being mean and scribbling all over my notes or anything! Walking to the ward, I turn over to my patient list and see:

Yes, that DOES say what you think it says.
("I want Angry to come and examine me...mmmm...")

Oh, I am feeling SO positive right now.

The Angry Medic Makes Grand Rounds

Grand Rounds, that famous weekly round-up of the best of the medical blogosphere, is up in its 13th incarnation of its 5th volume (no I can't understand its numbering system either --Ed.) at A Chronic Dose. And amazingly, my emo entry two posts ago was accepted and I made Grand Rounds.

Which is weird because I never make grand rounds on time in real life - leading to the nice collection of consultant-shaped bootprints growing on my arse. (Hell, once when I was on a surgical urology firm, the registrar in charge of ward rounds turned silently to me, right after I burst through the ward doors breathless from my marathon sprint up 8 flights of stairs, and said, dead seriously, "Maybe we should give you a hemi-vasectomy. To better help you understand the patient's experience." Then he turned back and resumed talking to the patient as if nothing had happened, oblivious to the fact that 5 junior doctors, 6 medical students, 3 nurses and about 80 patients had all heard him and were now staring at me with the same expression that you'd show a prisoner on his way to the guillotine (or Steven Seagal on his way to about any awards ceremony). Surgeons are scary bastards, aren't they? --Ed.)

Grand Rounds Vol. 5 No. 13

The Angry Medic learns from a patient that really, some wounds never heal.

Go check it out, it's full of posts a lot better than mine. Next week's Christmas Grand Rounds will be held at Highlight Health. Merry Christmas folks! And remember, leaving milk and cookies for Santa gives him diabetes.

The Adventure Begins (Again)

The Angry Medic's new home, a top socialist NHS

teaching hospital in London.

London! The financial centre of the world. A city bustling with life, teeming with people from all walks of life, headed towards all sorts of destinies. A metropolis full of excitement, dreams, possibilities, adrenaline--

-- and one clueless medical student who can't read a Tube map to save his life. (Literally. Who knew that chavs liked to beat up clueless-looking people wandering around in Cambridge University hoodies? And why the hell did they call me a "toff"? I don't even like toffee. --Ed.)

So I'm in London, situated at a top teaching hospital and finally in the thick of the good ol' socialist NHS. For simplicity's sake (and because I have fewer comedy ideas than Will Ferrell on a good day), I shall refer to my hospital as Stalingrad General Hospital from now on. (refer to above mind-bogglingly brilliant Photoshopped picture. Who needs sex when you have Photoshop? Who's with me? Huh? HUH? No not you David Schwimmer, you're just ugly. --Ed.)

Two months into clinical school, I have managed to acquaint myself with nearly every personality of note (and their respective bootprints, which have all become very good friends with my ass) in Stalingrad General, and for simplicity's sake (and because I have fewer comedy ideas than Prince Philip on a really, really good day) I shall refer to them all as they appear in the following Who's Who in Stalingrad General Hospital:

Komrade Professor - Our Professor of Medicine, in charge of the integration of Oxbridge transfer students into a "proper" medical school (read: teaching us poor pre-clinical sods how to hold a stethoscope properly.) Literally looks like a tanned version of Rowan Atkinson, complete with biting wit and a glare that makes you feel like Mr Bean presenting a chest x-ray.






Komrade Konsultant - Supreme Overlord of his medical specialty, and at the direct opposite end of the hospital food chain from me. I'll use this title for whoever's in charge of teaching me at the moment (read: bossing me around a bit, pretending they care about medical training, then disappearing faster than George W. Bush's approval ratings when I approach them for teaching).





Komrade Konsultant Surgeon - The consultant surgeon in charge, whenever I have the fantastic misfortune to be on a surgical specialty instead of a medical one. A heckuva lot more scarce than the medical variety, but (as any medical student will tell you) worse than medical consultants. A lot worse. (And hey, how appropriate will this picture be when I start Respiratory Surgery?)




Komrade Klinikal Skills Tutor - THE poor bastard in charge of teaching us poor bastards how to hold a stethoscope properly. Loses hair faster than John McCain lost the election. Probably got the job in return for a foreign work permit or because he got caught stealing cookies from Komrade Professor's personal tin. Either way, I pity the man. (And so will you, once you hear what we've done to him. --Ed.)




So there we go - a small sampling of the crazy characters perpetrating the wide-screen madness that goes on daily at my clinical school. (Boy, the stories I have for you! And I haven't even introduced the nurses yet.) Stay tuned*!

*Anybody (and I mean ANYBODY) who makes the ol' tuning-fork-neurological-exam joke at this point gets to be the first subject in my clinical trial to test whether humans can feel tuning-fork vibrations in the inner rectum, okay?